ABSTRACT
Hearing is one of the special senses god has bestowed upon human beings. One can really appreciate the value of hearing only when one ceases to hear. Unfortunately, in our country the hearing impaired individuals are ridiculed, where as the visually impaired are sympathized upon. Our country being a developing nation with poor socio-economic status and low environmental surroundings, chronic diseases of the ear account for nearly 5% of the population. One will not be surprised if the statistics reveal five crores chronic ear patients in our country. If this ailment is not corrected, the hardship faced by the patients will be tremendous. Hence, the purpose of ear surgery is to restore normal anatomical and physiological status of the ear, so that the patient leads a comfortable lifestyle. ENT surgeons by performing corrective surgery for chronic suppurative otitis media (CSOM) can change the lifestyles of their patients profoundly. The medical line of management will only lessen the severity of symptoms. With the present modern gadgets coupled with skill acquired by otologist. I will exhort every patient with CSOM to undergo corrective ear surgery as to ensure a healthy and normal life.
ABSTRACT
Temporal lobe herniation or meningoencephaloceles through the tegmen bone are rare entities but are well-described lesions in the literature. They can be successfully approached through the middle fossa alone or combined with a transmastoid approach, and are repaired with fascia, bone, or cartilage. However, cerebellar encephaloceles penetrating the posterior fossa dural plate and presenting as pulsatile postauricular mass are rare. In this paper, we report successful treatment of a cerebellar encephalocele by cranialization of the mastoid cavity using a calvarial bone graft and closure of the external auditory canal. A prior suboccipital approach, as recommended by others, had failed. The patient has remained well for 1 year with no recurrence.
ABSTRACT
STUDY OBJECTIVE: To compare the control of hemodynamic response to surgical stimulus of desflurane to that of isoflurane. DESIGN: Prospective randomized study. SETTING: Operating room of a major U.S. teaching hospital. PATIENTS: 59 ASA status I, II, and III patients 18 to 80 years of age and were undergoing orthopedic or intra-abdominal surgical procedures of 1 or more hours in duration. INTERVENTIONS: Group 1 (n = 29) received desflurane in oxygen (O2) for their surgical procedure. Group 2 (n = 30) received isoflurane in O2 for their surgical procedure. Thiopental sodium 4 mg/kg and fentanyl 3 micrograms/kg provided induction; vecuronium 0.1 mg/kg facilitated intubation. Prior to incision the volatile anesthesia drug was titrated to maintain systolic blood pressure (SBP) within 20% of preinduction (baseline) values. Any time after incision, an SBP increase greater than 20% of baseline was treated with a 30% increase in inspired anesthetic concentration for 3 minutes, or until SBP was within 10% of baseline. Another three 30% increases were allowed at 3 minute intervals to return SBP to 10% of baseline. If four 30% increases did not return SBP to 10% of baseline, additional fentanyl up to 5 micrograms/kg or labetalol in 5 mg increments was given. MEASUREMENTS AND MAIN RESULTS: Measurement of hemodynamics and anesthetic concentration occurred every 2 minutes prior to skin incision and every 5 minutes thereafter. Measurement of hemodynamics and anesthetic concentration occurred every minute during treatment of blood pressure (BP) response to surgical stimulus. Desflurane allowed for more rapid control of BP response to surgical stimulus median 2 minutes (range 1 to 12 minutes) for desflurane versus 6 minutes (range 1 to 12 minutes, p = 0.011). The desflurane group required fewer 30% incremental anesthetic increases than the isoflurane group (1.8 versus 2.5, p = 0.016) to control increased SBP. End tidal/inspired drug concentration ratios were closer to unity in the desflurane patients both before (0.94 versus 0.80) and after (0.86 versus 0.70) changes in drug concentration to treat increased SBP. CONCLUSIONS: Anesthetic depth can be more rapidly titrated with desflurane compared to isoflurane. Alveolar/inspired concentration ratio approaches unity more rapidly with desflurane anesthesia.
